Category: Professional Posters
Purpose: Neurokinin (NK)-1 receptor antagonists play a key role in the prevention of acute and delayed nausea associated with moderate and highly emetogenic chemotherapy. Until late 2017, fosaprepitant was the only one intravenous (IV) NK-1 receptor antagonist available. Fosaprepitant is a prodrug of aprepitant. The approval of IV aprepitant provides an alternative to fosaprepitant with similar pharmacokinetic profiles and indications. The purpose of this study is to document the cost savings after a therapeutic interchange from fosaprepitant to IV aprepitant at Kalispell Regional Medical Center.
Methods: This is a retrospective review of the cost savings from a therapeutic interchange from fosaprepitant to IV aprepitant. This interchange was reviewed and approved by the Pharmacy and Therapeutics Committee. Aprepitant 130mg IV was substituted for fosaprepitant 150mg beginning in October 2018 for adult patients. Patients already approved for fosaprepitant were continued on this therapy for the remainder of their regimen. Actual savings were calculated using actual acquisition costs and review of purchase data. Projected annualized savings were based on volume from the past 12 months and current pricing.
Results: Actual drug spend in the 6 months after the interchange decreased by over 20% while volume stayed relatively stable. 22% of the drug spend for these agents is on a GPO account while 78% is on a 340b account. Projected annualized savings are approximately $60,000.
Conclusion: The availability of a second IV NK-1 receptor antagonist warrants a review to determine the most cost-effective product for the prevention of acute and delayed nausea and vomiting associated with moderate and highly emetogenic chemotherapy. These two agents have similar pharmacokinetic profiles and indications, making a therapeutic interchange a straightforward choice to achieve cost savings. In hospitals with a similar profile, significant costs savings of over 20% can be expected.